HPE Chronic pain – part one | Page 5

and impotent). A high number of the relatives of those with chronic pain also suffer sadness and anxiety and withdraw from social activities themselves. 21 Effects on health care systems Pain accounts for considerable expenditure and consumption of resources in primary care. 27,28 In a study by Breivik et al,1 60% of chronic pain patients reported that they had visited their clinician 2–9 times in the months before the study commenced and that 11% had visited at least ten times. A total of 70% visited their GP, whereas only 2% were treated by pain specialist. People who leave their employment or lose their job as a result of pain, and those who perceive their pain affects their family, are those who use the healthcare systems the most. 21 It has also been shown that pain is often adequately diagnosed and treated in primary care, resulting in excessive appointments and overuse of healthcare resources. 21 Conclusions Based on the definition of disease, most chronic pain can be considered as a disease in its own right. The new ICD-11 classification acknowledges that chronic pain is a disease in its own right by introducing the coding of ‘chronic primary pain’. Yet, at the same time many patients with ‘secondary chronic pain’ have emotional distress and important interference with daily activities and social participation. As such, they fit into the concept of pain as a disease while their pain can be a symptom of an underlying disease. Chronification should be considered as a continuum where initially, pain could be a symptom, but can develop into a disease. Therefore, disease-specific treatment paradigms, focusing on multimodal strategies, need to be applied, which might differ from those were chronic pain is merely a symptom of an underlying chronic condition. Because of the high prevalence of chronic pain and the resultant serious medical and non-medical consequences, effective health care policies, acknowledging pain as a public health priority, and multidisciplinary treatment strategies to prevent and manage pain and minimise the disability that it causes, are required. In a study comparing health-related quality of life (HRQoL) in patients with acute pain and chronic pain with those without pain, chronic pain patients received the worst score in all dimensions of HRQoL. 24 Effect on work Studies have demonstrated that that absenteeism, presenteeism and early retirement related to chronic pain present a significant burden as least as great as conditions that are typically prioritised as public health concerns. 25 In the 45–65-year-old age group, low back pain is one of the most frequently cited medical reasons for loss of work. 26 Effect on social relationships and family Chronic pain can restrict a person’s leisure activities and social interactions. Family members often find that they need to undertake care duties and must become involved in decision making regarding medical treatment and consequently suffer negative feelings (including feeling overburdened, frustrated References 1 Breivik H et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006;10:287–333. 2 IASP Task Force on Taxonomy (eds Merskey H, Bogduk N). Classification of Chronic Pain, Second Edition. IASP Press, Seattle; 1994. 3 International Association for the Study of Pain (IASP). IASP’s proposed definition of pain released for comment. www. iasp-pain.org/PublicationsNews/ NewsDetail.aspx?ItemNumbe r=9218&navItemNumber=643 (accessed October 2019). 4 Williams AC, Craig KD. Updating the definition of pain. Pain 2016;157(11):2420–3. 5 Kosek E et al. Do we need a third mechanistic descriptor for chronic pain states? Pain 2016;157:1382–6. 6 IASP. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl 1986;3:S1– S226. 7 Treede RD et al. A classification of chronic pain for ICD-11. Pain 2015;156:1003–7. 8 ICD. MG30. Chronic pain. https://icd.who.int/dev11/l-m/ en#/http%3a%2f%2fid.who. int%2ficd%2fentity%2f15819 76053 (accessed October 2019). 9 IASP. IASP terminology. www. iasp-pain.org/Education/Content. aspx?ItemNumber=1698#Centra lsensitization (accessed October 2019). 10 Morlion B et al. Pain chronification: what should a non-pain medicine specialist know? CMRO 2018;34:1169–78. 11 Raffaeli W, Arnaudo E. Pain as a disease: an overview. J Pain Res 2017;10:2003–8. 12 IASP/EFIC. IASP now recommends the global adoption of EFIC’s Declaration on Chronic Pain as a Major Heathcare Problem, a Disease in its own Right. https://s3.amazonaws. com/rdcms-iasp/files/ production/public/Content/ ContentFolders/GlobalYearAgain stPain2/20042005RighttoPainRel ief/painasadisease.pdf (accessed October 2019). 13 World Health Organization. Preamble to the Constitution of the World Health Organization. WHO, New York, USA;1946. 14 Tracey I, Bushell MC. How neuroimaging studies have challenged us to rethink: is chronic pain a disease? J Pain 2009;10(11):1113–20. 15 Tracey I, Woolf C, Andrews N. Composite pain biomarker signatures for objective assessment and effective treatment. Neuron 2019;101(5):783–800. 16 World Health Organization. ICD-11. International Classification of Diseases 11th Revision. https://icd.who.int/en (accessed October 2019). 171 World Health Organization. International classification of functioning, disability and health: ICF. Geneva: WHO;2001. 18 Treede RD et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD- 11). Pain 2019;160:19–27. 19 Nicholas M et al. The IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain 2019;160:28–37. 20 ICD-11. MG30.0 Chronic primary pain. https://icd. who.int/browse11/l-m/ en#/http%3a%2f%2fid.who. int%2ficd%2fentity%2f13263 32835 (accessed October 2019). 21 Duenas M et al. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res 2016;9:457–67. 22 Reid KJ et al. Epidemiology of chronic non-cancer pain in Europe: narrative review of the prevalence, pain treatment and pain impact. Curr Med Res Opin 2011;27(2):449–62. 23 Bassols A et al. How does the general population treat their pain? A survey in Catalonia. J Pain Symptom Manage 2002;23:318–28. 24 Lopez-Silva M et al. Cavidol: quality of life in pain and primary care. Rev Soc Esp Dolor 2007;14:9–19. 25 Breivik H et al. OPENMinds. The individual and societal burden of chronic pain in Europe: the case for strategic prioritization and action to improve knowledge and availability of appropriate care. BMC Public Health 2013;13:1229. 26 Watson PJ et al. Medically certified work loss, recurrence and costs of wage compensation for back pain: a follow up study of the working population of Jersey. Br J Rheumatol 1998;37:82–6. 27 Blyth FM et al. Chronic pain and frequent use of health care. Pain 2004;111:51–8. 28 Keeley P et al. Psychosocial predictors of health-related quality of life and health service utilization in people with chronic low back pain. Pain 2008;135:142–50. hospitalpharmacyeurope.com | 2019 | 5